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<title>Emmaus -- Registrar's Office</title>
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	<img src="public/images/banner.png" style="height:95%; width:95%; padding-left:20px; padding-top:20px;" />
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    <h1 style="font-family:'Arial'; font-size:48px; position:relative; padding-left:110px; ">Enrolment Card</h1>
	<form id="form1" name="form1" method="post" action="">

	<label for="sy_txtbox" style="padding-left:75px;"> School Year:</label>	<input type="text" name="sy_txtbox" id="sy_txtbox" size="10" class="txt" />
        
	<label for="grede_level"> Grade Year/Level:</label>	<input type="text" name="grade_level" id="grade_level" size="8" class="txt"  />
    
    <h2>Student Profile:</h2>
    Name:
    <input name="fname" type="text" class="txt" id="fname" style="position:relative; left:11px;" />
	<input type="text" name="Mname" id="Mname" style="position:relative; left:11px; " class="txt"  />
    <input type="text" name="Lname" id="Lname" style="position:relative; left:11px; " class="txt"  />
    
    <br />
    <label for="fname" style="position:relative; margin-left:100px;">First Name</label>
    <label for="Mname" style="position:relative; left:90px;">Middle Name</label>
    <label for="Lname" style="position:relative; left:160px;">Last Name</label>
    <br />
        <label for="nick_txtbox">Nickname:</label><input type="text" name="nick_txtbox" id="nick_txtbox" class="txt" size="23" style="position:relative; left:5px;" />
	<label for="ccel_txtbox" style="position:relative; left:10px;">Child's Cell Phone#:</label><input type="text" name="ccel_txtbox" id="ccel_txtbox" style="position:relative; left:15px;" class="txt" size="16"  />
    <br />
    <label for="add_txtbox">Address:</label><input type="text" name="add_txtbox" id="add_txtbox" class="txt" size="30" style="position:relative; left:5px;" />
	<label for="tel_txtbox" style="position:relative; left:7px;">Landline Phone:</label><input type="text" name="tel_txtbox" id="tel_txtbox" style="position:relative; left:13px;" class="txt" size="16"  />
    <br />
    Birthday: <input type="date" name="bday" size="10" />
    Age: <input type="text" name="age_txtbox" id="age_txtbox" style="position:relative; left:5px;" class="txt" size="6"   />
    
    <label for="bp_txtbox" style="padding-left:5px;">BirthPlace:</label> <input type="text" name="bp_txtbox" id="bp_txtbox" style="position:relative; left:5px;" class="txt" size="22"  />
    <br />
    <label for="rel_txtbox">Religion:</label> <input type="text" name="rel_txtbox" id="rel_txtbox" style="position:relative; left:5px;" class="txt" size="22"  />
    
    <label for="church_add_txtbox" style="padding-left:5px;">Church Address:</label> <input type="text" name="church_add_txtbox" id="church_add_txtbox" style="position:relative; left:5px;" class="txt" size="23"  />
    <br />
    <label for="saved_txtbox">I (have/have not) accepted Christ as my Savior:</label> <input type="text" name="saved_txtbox" id="saved_txtbox" style="position:relative; left:4px;" class="txt" size="29"  />
    <br />
    <h2>Family Background:</h2>
    <label for="father_txtbox">Father:</label><input type="text" name="father_txtbox" id="father_txtbox" size="37px" class="txt" style="position:relative; left:5px;" />
	<label for="cel_txtbox" style="position:relative; left:15px;">Cell #:</label><input type="text" name="cel_txtbox" id="cel_txtbox" style="position:relative; left:25px;" class="txt"  />
    
    <br />
    <label for="f_occupation_txtbox">Occupation/Company:</label><input type="text" name="f_occupation_txtbox" id="f_occupation_txtbox" class="txt" />
	<label for="fc_tel_txtbox" style="position:relative; left:10px;">Phone:</label><input type="text" name="fc_tel_txtbox" id="fc_tel_txtbox" style="position:relative; left:20px;" class="txt"  />
    <br />
    <label for="fadd_txtbox">Address:</label><input type="text" name="fadd_txtbox" id="fadd_txtbox" class="txt" size="30" style="position:relative; left:5px;" />
	<label for="ftel_txtbox" style="position:relative; left:7px;">Landline Phone:</label><input type="text" name="ftel_txtbox" id="ftel_txtbox" style="position:relative; left:13px;" class="txt" size="16"  />
    <br />
    He (is/is not) a Christian. He is a member of <input type="text" name="fchurch_txtbox" id="fchurch_txtbox" style="position:relative; left:13px; padding-right:15px;" class="txt" size="28"  />
    <br />
    <br />
    <label for="mother_txtbox" >Mother:</label><input type="text" name="mother_txtbox" id="mother_txtbox" class="txt" size="37" style="position:relative; left:5px;"/>
	<label for="mcel_txtbox" style="position:relative; left:15px;">Cell #:</label><input type="text" name="mcel_txtbox" id="mcel_txtbox" style="position:relative; left:25px;" class="txt"  />
    <br />
    <label for="m_occupation_txtbox">Occupation/Company:</label><input type="text" name="m_occupation_txtbox" id="m_occupation_txtbox" class="txt" />
	<label for="mc_txtbox" style="position:relative; left:10px;">Phone:</label><input type="text" name="mc_txtbox" id="mc_txtbox" style="position:relative; left:20px;" class="txt"  />
			
    <br />
    <label for="madd_txtbox">Address:</label><input type="text" name="madd_txtbox" id="madd_txtbox" class="txt" size="30" style="position:relative; left:5px;" />
	<label for="mtel_txtbox" style="position:relative; left:7px;">Landline Phone:</label><input type="text" name="mtel_txtbox" id="mtel_txtbox" style="position:relative; left:13px;" class="txt" size="16"  />
    
        <br />
    She (is/is not) a Christian. She is a member of <input type="text" name="fchurch_txtbox" id="fchurch_txtbox" style="position:relative; left:11px; padding-right:15px;" class="txt" size="26"  />
    <br />
    <br />
    I have <input type="text" name="sis_txtbox" id="sis_txtbox" style="position:relative; left:5px;" class="txt" size="2"  /><label for="bro_txtbox" style="padding-left:10px;">sisters and</label><input type="text" name="bro_txtbox" id="bro_txtbox" style="position:relative; left:5px;" class="txt" size="2"   /><label style="padding-left:10px;">brothers.</label>
    <br />
    They are as follows:<input type="text" name="sib_txtbox" id="sib_txtbox" style="position:relative; left:13px; padding-right:15px;" class="txt" size="56"  />
    <br />
    <h2>Hobbies and Interest:</h2>
    
    I am interested in(Checked if applicable)
    <br />
    <input name="hobby" type="checkbox" value="Drama" />Drama		<input name="hobby" type="checkbox" value="Singing Solo" style="margin-left:55px; position:relative;" />Singing Solo		<input name="hobby" type="checkbox" value="Playing Bands" style="margin-left:55px; position:relative;" />Playing Bands
    <br />
    <input name="hobby" type="checkbox" value="Drawing" />Drawing		<input name="hobby" type="checkbox" value="Singing in Choir" style="margin-left:45px; position:relative;" />Singing in Choir	<input name="hobby" type="checkbox" value="Handicrafts" style="margin-left:33px; position:relative;" />Handicrafts
    <br />
    <input name="hobby" type="checkbox" value="Photography" />Photography		<input name="hobby" type="checkbox" value="Carpentry"  style="margin-left:15px; position:relative;" />Carpentry		<input name="hobby" type="checkbox" value="Leading Bible Class" style="margin-left:76px; position:relative;" />Leading Bible Class
    <br />
    <input name="hobby" type="checkbox" value="Playing Piano" />Playing Piano		<input name="hobby" type="checkbox" value="Sounds/lights" style="margin-left:7px; position:relative;" />Sounds/lights		<input name="hobby" type="checkbox" value="Drawing/Sketching" style="margin-left:52px; position:relative;" />Drawing/Sketching
    <br />
    <input name="hobby" type="checkbox" value="Playing Guitar" />Playing Guitar		<input name="hobby" type="checkbox" value="Sports"  style="margin-left:6px; position:relative;" />Sports(specify)	<input type="text" name="hobby_sports_txtbox" id="hobby_sports_txtbox" class="txt" size="26" />
    <br />
    <input name="hobby" type="checkbox" value="Decorating" />Decorating		<input name="hobby" type="checkbox" value="Teaching Children" style="margin-left:26px; position:relative;" />Teaching Children <input name="hobby" type="checkbox" value="Computer Graphics" style="margin-left:20px; position:relative;" />Computer Graphics
    <br />
    		<input name="hobby" type="checkbox" value="Others" />Others(Specify)<input type="text" name="other_hobby_txtbox" id="other_hobby_txtbox" class="txt" size="47" style="margin-left:5px;" />
	<br />
	<br />
    Favorite Past-time<input type="text"  name="past_time_txt" class="txt" size="47" style="margin-left:5px;" />
    <br />
    Last School Year I'm involve in<input type="text" name="club_txt" class="txt" size="28" style="margin-left:5px;" />Club
    <br />
    I obtained the following awards last year: <input type="text" name="awards_txt" class="txt" size="68" />
    <br />
    My best subject in the class is <input type="text" name="best_subj_txt" class="txt" size="16" />
    <br /> and the worst one is <input type="text" name="worst_subj_txt" class="txt" size="27" />
    <br />I obtained <input type="text" name="gen_ave_txt" class="txt" size="8"  /> General Average last year.
    <br />At home we speak <input type="text" name="home_lang_txt" class="txt" size="28" />
    <br />I can speak english fluently: <input type="radio" name="eng_fluent" value="yes" />YES <input type="radio" name="eng_fluent" value="no" /> NO
    <br />My <input type="text" name="help_txt" class="txt" size="34" /> usually help me with my homeworks.
    <br />
    <br />Guardian's Name: <input type="text" name="guardian_txt" class="txt" size="32" />
    <br />Relationship: <input type="text" name="guardian_rel_txt" class="txt" size="16" />
    <br />Date: <input type="date" />
    <br />
    <br />
    
            
          
			<input name="save" type="submit" value="Save" style="width:100px; height:40px; position:relative; left:400px;" />
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